聚桂醇在食管裂孔疝治疗中的应用研究

Effect of lauromacrogol in treatment of hiatal Hernia

目的探讨聚桂醇在食管裂孔疝(HH)治疗中的疗效。方法选取HH患者69例,常规进镜至胃腔,退镜至食管膈裂孔压迹处,通过内镜活检孔插入注射针,在食管膈裂孔压迹处、齿状线处及LES区环周分别多点注射聚桂醇,点间隔1 cm,总量小于10 ml,每周一次,4次为一个疗程。疗程结束后1个月再次测定食管pH值、食管压力并胃镜检查,比较注药前后患者的食管pH值、食管压力指数、内镜下黏膜改变及临床症状改善情况。结果注药后1个月的食管pH值、食管压力及齿状线与膈食管裂孔压迹的距离与注药前比较,差异有统计学意义(P<0.05)。注药后反流性食管炎内镜分级提高、临床症状明显改善。结论聚桂醇注射于LES区及膈裂孔区可改善食管内酸性环境,降低酸暴露时间,提高食管下段括约肌的压力,可在短时间内有效的改善临床症状,提高非手术治疗者的生存质量。

Objective To evaluate the efficacy of endoscopic submucous injection of lauromacrogol in the treatment of hiatal hernia. Methods A total of 69 patients with hiatal hernia were enrolled in the study. After gastroscope was drawn back to the esophageal diaphragmatic hiatus, muhi-point submucosal injection of lauromacrogol was performed in the esophageal diaphragmatic hiatus, pectinate line and LES circumferential area once a week. There were four times in a course of treatment. The interval of injection point was lcm and the total dose of lauromacrogol was less than 10ml. One month after the course of treatment, esophageal pH, esophageal pressure, endoscopic mucosal changes and clinical symptoms were compared with those before injection. Results There were significant differences in terms of esophageal pH, esophageal pressure and the length between pectinate line and diaphragmatic esophageal hiatus before and after administration of lauromacrogol （ P 〈 0. 05 ）. After injection, endoscopic grade of reflux esophagitis and clinical symptoms were improved significantly. Conclusions Endoscopic injection of lauromacrogol can improve the acidic environment, reduce acid exposure time and increase lower esophageal sphincter pressure. Therefore, it is effective to improve the clinical symptoms and the life quality of non-surgical patients with hiatal hernia in a short period.